F15

Caffeine is the most widely consumed psychoactive substance in the world two thirds of those who consume large amounts of caffeine daily also use sedative and hypnotic drugs Caffeine methylxanthine

Neuropharmacology
Caffeine acts primarily as an antagonist of the adenosine receptors. Adenosine receptors activate an inhibitory G protein (Gi) and, thus, inhibit the formation of the secondmessenger cyclic adenosine monophosphate (cAMP) increase in intraneuronal cAMP affect dopamine and noradrenergic neurons clinical reports associating caffeine intake with an exacerbation of psychotic symptoms in patients with schizophrenia. Activation of noradrenergic neurons has been hypothesized to be involved in the mediation of some symptoms of caffeine withdrawal.

 Doses of caffeine in the range of 300 to 800 mg (the equivalent of several cups of brewed coffee ingested at once) produce effects that are often rated as being unpleasant, such as anxiety and nervousness caffeine results in global cerebral vasoconstriction, with a resultant decrease in cerebral blood flow (CBF) cause a similar constriction in the coronary arteries and produce angina in the absence of atherosclerosis

DSM-IV-TR Caffeine-Related Disorders

Caffeine-induced disorders Caffeine intoxication Caffeine-induced anxiety disorder Specify if: With onset during intoxication Caffeine-induced sleep disorder Specify if: With onset during intoxication Caffeine-related disorder not otherwise specified

DSM-IV-TR Diagnostic Criteria for Caffeine Intoxication

Recent consumption of caffeine, usually in excess of 250 mg (e.g., more than 23 cups of brewed coffee). Five (or more) of the following signs, developing during, or shortly after, caffeine use:
restlessness nervousness excitement insomnia flushed face diuresis gastrointestinal disturbance muscle twitching rambling flow of thought and speech tachycardia or cardiac arrhythmia periods of inexhaustibility psychomotor agitation

The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder (e.g., an Anxiety Disorder).

 The caffeine-related disorder not otherwise specified category is for disorders associated with the use of caffeine that are not classifiable as caffeine intoxication, caffeineinduced anxiety disorder, or caffeine-induced sleep disorder. An example is caffeine withdrawal

DSM-IV-TR Diagnostic Criteria for Caffeine- Related Disorder Not Otherwise Specified

DSM-IV-TR Research Criteria for Caffeine Withdrawal

Prolonged daily use of caffeine. Abrupt cessation of caffeine use, or reduction in the amount of caffeine used, closely followed by headache and one (or more) of the following symptoms:
marked fatigue or drowsiness marked anxiety or depression nausea or vomiting

The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to the direct physiological effects of a general medical condition (e.g., migraine, viral illness) and are not better accounted for by another mental disorder

DSM-IV-TR Diagnostic Criteria for Substance-Induced Anxiety Disorder

Prominent anxiety, panic attacks, or obsessions or compulsions predominate in the clinical picture. There is evidence from the history, physical examination, or laboratory findings of either (1) or (2): the symptoms in Criterion A developed during, or within 1 month of, substance intoxication or withdrawal medication use is etiologically related to the disturbance The disturbance is not better accounted for by an anxiety disorder that is not substance induced. Evidence that the symptoms are better accounted for by an anxiety disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence suggesting the existence of an independent nonsubstance-induced anxiety disorder (e.g., a history of recurrent nonsubstance-related episodes). The disturbance does not occur exclusively during the course of a delirium. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

DSM-IV-TR Diagnostic Criteria for Substance-Induced Sleep Disorder

A prominent disturbance in sleep that is sufficiently severe to warrant independent clinical attention. There is evidence from the history, physical examination, or laboratory findings of either (1) or (2): the symptoms in Criterion A developed during, or within a month of, substance intoxication or withdrawal medication use is etiologically related to the sleep disturbance The disturbance is not better accounted for by a sleep disorder that is not substance induced. Evidence that the symptoms are better accounted for by a sleep disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent nonsubstance-induced sleep disorder (e.g., a history of recurrent nonsubstance-related episodes). The disturbance does not occur exclusively during the course of a delirium. The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Signs and Symptoms

50 to 100 mg of caffeine increased alertness, a mild sense of well-being, and a sense of improved verbal and motor performance. Caffeine ingestion is also associated with diuresis, cardiac muscle stimulation, increased intestinal peristalsis, increased gastric acid secretion, and (usually mildly) increased blood pressure, cholesterol-elevating compounds

 contraindicated for various conditions, including generalized anxiety disorder, panic disorder, primary insomnia, gastroesophageal reflux, and pregnancy

Treatment
Analgesics, such as aspirin, almost always can control the headaches and muscle aches that may accompany caffeine withdrawal. Rarely do patients require benzodiazepines to relieve withdrawal symptoms